European Study Shows Patients Need More Help to Lose Weight After Heart Events

July 28, 2021—The European Society of Cardiology (ESC) announced the publication of a study suggesting that weight loss is given insufficient priority in the management of heart patients despite the benefits.

The study, “Potential for optimizing management of obesity in the secondary prevention of coronary heart disease” by Professor Dirk De Bacquer, PhD, et al, is available online ahead of print in the ESC journal, Quality of Care and Clinical Outcomes.

According to ESC, the study was composed of more than 10,000 patients.

Patients in the study had the following characteristics:

• Less than 20% of patients had a healthy body mass index at the time of hospitalization for a heart event.
• Approximately 16 months after the event, 86% of patients who were obese during hospitalization were still obese and 14% of overweight patients had become obese.
• Approximately half of young women under age 55 years were obese.

However, more than a third of obese patients said they had not received advice on physical activity or nutrition and nearly one in five said they had not been informed that they were overweight. As quoted in the ESC announcement, the investigators stated, “It seems that obesity is not considered by physicians as a serious medical problem, which requires attention, recommendations, and obvious advice on personal weight targets.”

The ESC press release noted that weight loss is strongly recommended in overweight and obese patients with coronary heart disease to improve blood pressure and lipid levels and to reduce the risk of type 2 diabetes, thereby lowering the likelihood of another heart event.

As summarize by the ESC, the study investigated the management of patients who were overweight or obese at the time of hospitalization for a first or recurrent heart event (eg, heart attack or elective procedure to unblock clogged arteries). The investigators examined lifestyle advice received, actions taken, and the relationship between weight changes and health status.

The investigators pooled data from the EUROASPIRE IV (2012 to 2013) and EUROASPIRE V (2016 to 2017) studies, which were conducted in 29 countries. The analysis included 10,507 patients with coronary heart disease.

Patients were visited 6 to 24 months after hospitalization for their heart event (the average gap was 16 months). The visit consisted of an interview, questionnaires, and a clinical examination including weight, height, and blood tests.

The ESC announcement stated that one in four participants (24.8%) in the study were women and the average age at the time of hospitalization was 62.5 years. At the time of hospitalization, 34.9% of patients were obese and another 46% were overweight.

By the time of the study visit (on average 16 months later), an even greater proportion of patients were obese (36.9%). Rates of obesity rates were higher in younger patients with a prevalence of 40.1% in those aged under 55 years (men 38.3%, women 48.4%).

Regarding the link between weight changes and health status, overweight or obese patients who lost 5% or more of their body weight had significantly lower levels of hypertension, dyslipidemia, and previously unrecognized diabetes compared to those who gained 5% or more of their body weight—despite being equally treated with blood pressure and lipid lowering medications. They also reported higher levels of physical and emotional quality of life.

Regarding the advice patients received, half of all patients were advised to follow a cardiac prevention and rehabilitation program, with no difference in advice according to their weight status. For obese patients, less than two-thirds were advised to follow dietary recommendations (63.7%) or to do regular physical activity (64.2%).

Positive associations were found between lifestyle improvements and weight loss in obese or overweight patients. Compared to patients who gained 5% or more of their body weight, those patients who lost at least 5% of their body weight had more frequently reduced fat and sugar intake, increased consumption of fruit, vegetables, and fish, done regular physical activity, attended a cardiac rehabilitation and prevention program, and followed dietary advice from a health professional.

Finally, the investigators found that weight gain was significantly associated with smoking cessation. In patients who were overweight or obese at hospitalization, those who quit smoking gained 1.8 kg on average in contrast to the 0.4 kg average weight gain observed in persistent smokers, reported the ESC press release.

Study investigator Professor Catriona Jennings, PhD, of the National University of Ireland in Galway, Ireland stated that cardiac rehabilitation programs, which typically emphasize exercise, should give equal priority to dietary management.

Professor Jennings commented in the ESC press release, “Weight loss is best achieved by adopting healthy eating patterns and increasing levels of physical activity and exercise. Whilst actively trying to lose weight at the same time as trying to quit smoking is not advised, adopting a cardioprotective diet and becoming more physically active has the potential to mitigate the effects of smoking cessation on weight gain in patients trying to quit. Their aim is to maintain their weight and to avoid gaining even more weight following their quit.”

Professor Jennings continued, “Uptake and access to cardiac rehabilitation programs is poor with less than half of patients across Europe reporting that they completed a program. Such programs would provide a good opportunity to support patients in addressing overweight and obesity, especially for female patients who were found to have the biggest problem with overweight and obesity in the study.”

In conclusion, Professor Jennings stated, “Uptake and access could be improved with the use of digital technology, especially for women, who possibly are less likely to attend a program because they have many other competing priorities, such as caring for others. There are good reasons for people to address their weight after a cardiac event—but it’s not easy and they do need help.”